s a graduate student in the Child Psychiatry Department at Yale, I am well informed about mental health and surrounded by world-renowned psychiatrists. I
used to believe that I would be well positioned to navigate Yale's mental health services. I don't believe that anymore.

My symptoms began with worries that crept in surreptitiously. Double-checking statistics? Normal. Triple-checking statistics? Normal. Being convinced that
I may have committed academic fraud by falsifying data because I could not find concrete evidence that I didn't falsify data? Not ideal. Sitting at home
trying to block out the thoughts in my head that a girl who fell down under my supervision had appeared fine but died in her sleep from a brain hemorrhage?
Not OK.

I called Yale's Mental Health Department. When I first explained my obsessive worrying to my assigned therapist, he seemed genuinely concerned.

One night, I was struck by the fear that I had hit someone with my car. I would call it a "realization," except for the fact that it wasn't real. I
contacted a friend, who advised me to call Yale Mental Health. My therapist was away, so I called the emergency line.

After establishing that I wasn't suicidal, the emergency responder replied with "Well, what do you want me to do?"

So I wasn't going to kill myself, but what was I supposed to do about the fact that I might have killed someone else? While browsing the Internet for news
of local car accidents, I learned that I was experiencing common symptoms of obsessive compulsive disorder (OCD).

The recommended treatment for OCD is cognitive behavioral therapy (CBT), which includes planned exposures to anxiety-inducing situations and homework
assignments in which patients record their worrying thoughts. Guidelines for treatment of OCD suggest CBT and medications such as Prozac as first-line
treatments.

After a long run of therapy that was not, fast-forward to me causing a real
car accident. While leaving a gas station, my car was hit from behind, coming to a full stop as it hit a telephone pole. My parents came from New York to
pick me up. My lethargic, silent ruminations seemed to them like a normal reaction to the accident. I didn't tell them that that was how I had spent the
last several months of my life.

In the back of a book on my nightstand, I wrote a list: "For when I die." It included where to scatter my ashes and how to tell people I died: "If I kill
myself, don't tell [my students], make up some other cause of death PLEASE." Desperate, I told a consulting psychiatrist I wanted to try medication.

Many, many milligrams of Prozac later, I began to feel like a normal person again. Actually, that's not true. I felt completely abnormal. I lost 25 pounds.
I slept through most of the day. Occasionally at night, I would wake up with nausea that felt like food poisoning. But Prozac helped the worries. I still
thought about car accidents, but now this worry could be pacified by carefully checking my car for scratches. My Yale Mental Health therapist finally gave
me an assignment to get a notebook to record my worries.

After establishing that I wasn't suicidal, the emergency responder replied with “Well, what do you want me to do?”

T

wo weeks passed with no mention of the homework, so I pulled out the notebook at the end of the session.

He took the notebook from me and began reading out loud. He paused and addressed me directly.

"You were afraid you hit someone with your car at a gas station? Isn't your car not even moving when you are getting gas?"

During our next session, he again forgot to mention my notebook, and I articulated my frustration with his services. He called me to apologize, and told me
I had distracted him during the session with my complaints of feeling faint. I called the patient representative at Yale Health and asked for a different
therapist.

Therapist #2 was nice. I asked her specifically for CBT. What I got was a 30-minute session once a week with no structured exposures and no written
homework. My reaction? "Student mental health is unequipped to offer standard CBT treatment for OCD, so I'd like a referral to an outside therapist
please."

"We don't give referrals."

I was confused. The student handbook says "If in the course of medical evaluation and treatment, a member requires outpatient services not provided at the
Yale Health Center, the member's primary care clinician may make a referral to an approved specialist in the Yale Health network outside the Yale Health
Center." Was mental health different from physical health? Last time I checked, my mind was part of my body. I emailed my concerns to Dr. Lorraine Siggins,
Chief of Mental Health and Counseling. No response.

A new semester started, and I felt like giving up. I inquired about a medical leave.

On leave, I would have no main source of income, since graduate school is my full-time job. I would also have no health care (being over 26, my parents'
healthcare wouldn't help). When I asked Dr. Siggins to approve my medical leave in time for Yale to avoid paying my semester's tuition, I finally got a
meeting with her.

During the confusion of arranging a leave, therapist #2 switched me to a third therapist whom I was scheduled to meet one day before meeting with Dr.
Siggins. Dissuaded by the financial impracticality of taking a medical leave, I called Dr. Siggins the morning of our meeting to cancel. I am currently
enrolled as a full-time graduate student.

I'm not better. Despite knowing exactly what treatment to ask for, it took nearly a year to receive what I hope will be acceptable care at Yale Health. I
feel that someone without my level of knowledge, arriving at Yale Mental Health needing treatment for serious mental illness, would have little hope. If
you require more than brief weekly sessions of generalized therapy, Yale Mental Health is probably not the place for you. And they don't make referrals.

Danielle Bolling is a third year student in the Graduate School of Arts & Sciences. Contact her at danielle.bolling@yale.edu.

I'm not better. Despite knowing exactly what treatment to ask for, it took nearly a year to receive what I hope will be acceptable care at Yale Health.